Citation Nr: 0312883
Decision Date: 06/16/03 Archive Date: 06/24/03
DOCKET NO. 00-18 830A ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Muskogee,
Oklahoma
THE ISSUE
Entitlement to service connection for hypertension.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
L. M. Barnard, Counsel
INTRODUCTION
The veteran served on active duty from January 1961 to
January 1964 and from September 1980 to September 1984. He
was on active duty for training from April 29 to August 9,
1986.
This appeal arose from an April 2000 rating decision of the
Muskogee, Oklahoma, Department of Veterans Affairs (VA)
Regional Office (RO), which denied entitlement to the benefit
requested. By decision dated in September 2002, the Board of
Veterans' Appeals (Board) found that the evidence submitted
by the veteran was new and material and his claim for service
connection for hypertension was reopened. In September 2002
and April 2003, the Board conducted internal development of
this case. The case is again before the Board for appellate
consideration.
FINDING OF FACT
The veteran does currently suffer from hypertension which can
be related to his period of service.
CONCLUSION OF LAW
Hypertension was incurred in service. 38 U.S.C.A. §§ 1131,
5103A, 5107 (West 2002); 38 C.F.R. § 3.159 (2002).
REASONS AND BASES FOR FINDING AND CONCLUSION
The veteran has contended that he currently suffers from
hypertension which had its onset during active duty.
Therefore, he believes that service connection is warranted.
In the interest of clarity, the factual background of this
case will initially be set forth. The relevant laws and
regulations will then be briefly reviewed. Finally, the
Board will analyze the case and render a decision.
Factual background
The veteran's service medical records from his 1961 to 1964
period of service show no complaints of or treatment for
hypertension. His January 1961 entrance examination and his
November 1963 separation examination noted that his blood
pressure was within normal limits. The veteran re-entered
service in 1980. On February 11, 1981, he complained of
chest pain, shortness of breath and diaphoresis. His blood
pressure readings were noted to be 160/110, 140/100 and
120/88. From February 13 to 23, 1981, he underwent a blood
pressure study, where his readings were taken several times
per day. All the readings were normal. It was determined
that he had had an acute anxiety reaction/hyperventilation
episode which had been precipitated by wearing a M17
protective mask. His blood pressure readings throughout the
remainder of his service were normal. Hypertension was not
diagnosed during service.
The veteran underwent an examination of his low back in
January 1985. His blood pressure was 118/80.
The veteran served on active duty for training from April 29
to August 9, 1986. He was authorized continuation of pay and
allowance for an appointment on September 29, 1986. He was
then hospitalized for complaints of chest pain and shortness
of breath. He was noted to have cardiomyopathy and coronary
artery disease, which were felt to be most likely related to
alcohol use. There was no indication of hypertension, since
all but two of many blood pressure readings recording during
the hospitalization were normal
In October 1986, blood pressure was 132/90. It was noted
that the veteran had received extensive evaluations for
cardiac complaints and they had been negative.
The veteran was afforded a VA examination in September 1993.
He claimed that he had been treated for hypertension for 10
to 15 years; in 1986 he was hospitalized for chest pain,
after which it was found that he had coronary artery disease.
His blood pressure readings were 154/94 (sitting); 160/100
(standing); and 156/96 (sitting). Hypertension was
diagnosed. A February 1996 VA joints examination noted blood
pressure of 156/94.
In December 1999, a VA physician noted that the veteran's
service records had shown hypertension back to at least 1981.
Therefore, it was opined that hypertension had begun in
service. In December 2000, he was awarded Social Security
Administration benefits based on heart and kidney disease.
VA re-examined the veteran in December 2002. At the time of
this examination, the veteran stated that his hypertension
had begun in the mid-1960's, although he had been
asymptomatic at that time. No treatment had been received at
that time; he started taking medications for this condition
in the 1980's. He indicated that he had suffered a possible
heart attack in 1984 and a second heart attack in 1993. His
current symptoms included occasional chest pressure with
shortness of breath. His blood pressure readings were as
follows: 175/81 (sitting); 131/72 (standing); and 188/82
(laying down). The examiner then stated that
On C-file review, the patient had two episodes of
hypertension in military service. The veteran had
blood pressure of 160/110 in February 1981 and a
blood pressure of 140/100 in September 1982. Both
episodes occurred while the veteran was
experiencing chest pain. All other blood pressure
readings, random and sequential were within normal
limits during military service. The veteran was
discharged from military service in 1984. Multiple
blood pressure readings in 1986 were within normal
limits. Overall, analysis of blood pressure
readings during military service shows the veteran
did not have hypertension during or one year after
military service. Therefore, it is my opinion that
it is less likely than not that the veteran's
hypertension had its onset during active service or
within one year after military service.
Another examination of the veteran was performed in May 2003.
The veteran indicated that he was first treated for
hypertension while in service. He noted that ever since that
time, his blood pressure readings have been erratic. The
examiner then reviewed the chart. It was commented that
I have reviewed the veteran's medical records while
in service, and I saw that the first time he was
seen to have high blood pressure was after he had
most probably a panic attack secondary to
claustrophobia. This was on February 11, 1981, and
at that time his blood pressure was 160/110 and
then they rechecked it; it was 140/100, and then on
the same day it was 120/88 in the evening.
There are multiple instances in his chart where his
blood pressure has been a little high, but then the
next time he went and his blood pressure has been
normal. After the initial high blood pressure, he
was sent in for weekly monitoring of his blood
pressure, but during that week, his blood pressure
was not high at any time. I have blood pressure
readings from 20 March '84 where the veteran's
blood pressure was 140/70. Then I have another
blood pressure reading on 15 August '83 where his
blood pressure was 140/82. Then other blood
pressures, like on 9 November 1983, were normal,
110/72. Then another blood pressure reading from 5
July 1983, blood pressure was 126/76. Another
blood pressure on 8 July was 128/76. Another blood
pressure 8 April '83 110/88. Another blood
pressure reading on 26 January; I cannot see the
year of this, but it was 121/82. Then there is
another blood pressure reading 140/78, and this was
on 24 January 1983. Then 14 December 1982 it was
140/90. Then another blood pressure reading on 21
October 1981 was 138/86. Another blood pressure
reading on 20 October 1986 was 132/90, and at that
time he was diagnosed to have some sort of a
cardiomyopathy. But like I said, there are dates
from 23 February 1981 where he went in for blood
pressure checks, both in his right arm and left arm
lying, sitting and standing where his blood
pressure did not go above 120/80. This was soon
after he was seen to have high blood pressure. So
after they did these repeated checks, they never
commented on his blood pressure again. Also, there
is a discharge summary from 9/18/1986 where the
discharge diagnosis was cardiomyopathy likely
secondary to alcohol and mild coronary artery
disease (this was at Ft. Sill, Oklahoma) because he
went in with chest pain at that time. Also, on 29
September 1982, in his history they have mentioned
hypertension plus/minus as a risk factor for heart
disease.
So, there are a number of instances where his blood
pressure has been more than 140/90. So, after
reviewing all the medical records, I find it more
than likely that his high blood pressure started
while in service.
Relevant laws and regulations
Under the applicable criteria, service connection may be
granted for a disability the result of disease or injury
incurred in or aggravated by service. 38 U.S.C.A. § 1131
(West 2002).
Standard of review
After the evidence has been assembled, it is the Board's
responsibility to evaluate the entire record. See
38 U.S.C.A. § 7104(a) (West 2002). When there is an
approximate balance of evidence regarding the merits of an
issue material to the determination of the matter, the
benefit of the doubt in resolving each such issue shall be
given to the claimant. 38 U.S.C.A. § 5107 (West 2002);
38 C.F.R. §§ 3.102, 4.3 (2002). In Gilbert v. Derwinski, 1
Vet. App. 49, 53 (1990), the Court stated that "a veteran
need only demonstrate that there is 'an approximate balance
of positive and negative evidence' in order to prevail." To
deny a claim on its merits, the preponderance of the evidence
must be against the claim. See Alemany v. Brown, 9 Vet. App.
518, 519 (1996), citing Gilbert, 1 Vet. App. at 54.
Analysis
VCAA
The Board notes that in May 2002, the RO sent a supplemental
statement of the case (SSOC) to the veteran informing him of
the provisions of the Veterans Claims Assistance Act of 2000,
Pub. L. No. 106-475, 114 Stat. 2096 (2000) (VCAA). In this
SSOC, he was informed of the evidence that was already of
record and of what evidence was needed to substantiate his
claim. He was also told of what VA would do to assist him
and of what his duties were. Therefore, it is found that VA
has met its duties of notice and development pursuant to the
provisions of the VCAA.
Discussion
After a careful review of the evidence of record, it is found
that entitlement to service connection for hypertension has
been established. While it is true that hypertension was
never diagnosed in service, the record contains opinions
rendered in December 1999 and May 2003 that his hypertension
more than likely began in service. The Board does note the
December 2002 VA opinion which disagreed with the conclusion,
finding that his hypertension was not incurred in service or
during the one year presumptive period following his
discharge. However, in such cases where the evidence is in
equipoise, the veteran prevails. See Gilbert v. Derwinski, 1
Vet. App. 49 (1990) (which states that, when all the evidence
is assembled, VA is responsible for determining whether the
evidence supports the claim or is in relative equipoise, with
the veteran prevailing in either event, or whether a
preponderance of the evidence is against a claim, in which
case, the claim is denied.)
Therefore, after weighing all the evidence of record and
after resolving any doubt in the veteran's favor, it is found
that the evidence is in equipoise. As a consequence, it is
determined that entitlement to service connection for
hypertension has been established.
ORDER
Service connection for hypertension is granted.
____________________________________________
James R. Siegel
Acting Veterans Law Judge, Board of Veterans' Appeals
IMPORTANT NOTICE: We have attached a VA Form 4597 that tells
you what steps you can take if you disagree with our
decision. We are in the process of updating the form to
reflect changes in the law effective on December 27, 2001.
See the Veterans Education and Benefits Expansion Act of
2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the
meanwhile, please note these important corrections to the
advice in the form:
? These changes apply to the section entitled "Appeal to
the United States Court of Appeals for Veterans
Claims." (1) A "Notice of Disagreement filed on or
after November 18, 1988" is no longer required to
appeal to the Court. (2) You are no longer required to
file a copy of your Notice of Appeal with VA's General
Counsel.
? In the section entitled "Representation before VA,"
filing a "Notice of Disagreement with respect to the
claim on or after November 18, 1988" is no longer a
condition for an attorney-at-law or a VA accredited
agent to charge you a fee for representing you.